AMCP: The Academy of Managed Care Pharmacy

There are 6 key issues that market access teams are facing amid evolving marketplace trends in the pharmaceutical industry, said Douglas Long, BS, MBA, vice president, industry relations, IQVIA, when speaking at the headline session of the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts.

Migraine is a chronic illness, but many people, including both patients and healthcare providers­, don’t think of it that way, said Richard G. Wenzel, PharmD, CPPS, speaking at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts.

There is a lot of competition in specialty pharmacy right now, said Aimee Tharaldson, PharmD, a senior clinical consultant in Emerging Therapeutics for Express Scripts.

Brandon Newman, PharmD, MMHC, CSP, program director, specialty pharmacy, Vanderbilt University Medical Center, explains the benefits of collaboration between payers and academic centers and how this collaboration, in turn, benefits patients.

When Robert Navarro, PharmD, started his career decades ago at a managed care company, healthcare as a percentage of the gross domestic product was 8%. Now, the clinical pharmacy professor noted, the figure is at nearly 18% and rising, and the industry keeps having a conversation about value­. Speaking at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting, held April 23-26, in Boston, Massachusetts, he and Ashok Vegesna, PharmD, MS, of Novartis, spoke about Visions of a Value-Based Health Care System.

Through Medication Therapy Management, a pharmacist will be able to recognize indications of potential opioid abuse, explained Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare.

Value-based care can only occur if it is transformative throughout an entire healthcare system or a component of the healthcare system, said Robert Navarro, PharmD, clinical professor, College of Pharmacy, University of Florida.

At the Academy of Managed Care Pharmacy's Managed Care & Specialty Pharmacy Annual Meeting, held April 23-26, in Boston, Massachusetts, an overflow capacity crowd gathered for one of the meeting’s yearly highlights­: Specialty Pharmaceuticals in Development. Aimee Tharaldson, PharmD, a senior clinical consultant in Emerging Therapeutics for Express Scripts, talked about the key trends in the specialty drug market, including cancer drugs, new competition, and orphan drugs.

Jennifer Graff, PharmD, vice president of comparative effectiveness research at the National Pharmaceutical Council, discusses where payers receive their information and how it is used to make decisions about coverage and reimbursement.

Prescribers and pharmacies can encounter some unique challenges when specialty drugs are e-prescribed, but organizations like the National Council for Prescription Drug Programs are trying to make the process smoother, explained Laura Topor, president of Granada Health.

Informed consent is one of the principal values in healthcare, but it should include discussions about cost, said Jacqueline Glover, PhD, professor in the Department of Pediatrics and the Center for Bioethics and Humanities at the University of Colorado Denver. Glover also discussed the need to clarify the language surrounding end-of-life care.

Real-time prescription benefit transactions are designed to give clinicians essential information on an individual patient’s benefits before writing a prescription, according to Laura Topor, president of Granada Health.

Clinicians have obligations of justice when treating patients, which can lead to difficult decisions on how to ethically allocate limited resources to patients as a whole, said Jacqueline Glover, PhD, professor in the Department of Pediatrics and the Center for Bioethics and Humanities at the University of Colorado Denver.

Working with real-world evidence-based data can pose difficulties, both when collecting and analyzing the information, but redesigned incentives could help drive entities to provide more information, said Lou Garrison, PhD, professor emeritus in the Department of Pharmacy, University of Washington.

All stakeholders stand to gain from the 340B program in different ways, but they also take on different risks, like the potential impact for health plans on rebate contracts, said Neil Minkoff, MD, chief medical officer of EmpiraMed.

A measure developer's work isn't done once a quality measure is created-the Pharmacy Quality Alliance (PQA) works with health plans post-implementation on questions regarding measure specifications or measure calculations, explained Matthew Pickering, PharmD, RPh, associate director of research and quality strategies at PQA.

Many people may think e-prescribing refers to the electronic sending of a prescription, but the term actually encompasses a much broader range of communications and transactions, said Laura Topor, president of Granada Health.

When conducting drug trials, the values of patients and manufacturers can come into conflict, which is why a well-informed ethical framework is needed to evaluate benefits and burdens, according to Jacqueline Glover, PhD, professor in the Department of Pediatrics and the Center for Bioethics and Humanities at the University of Colorado Denver.

When using real-world data, researchers must be careful to avoid several common pitfalls that can bias their results, according to Richard J. Willke, PhD, chief science officer of ISPOR.

The Academy of Managed Care Pharmacy (AMCP) is working with Congress to improve communication both in the pre- and post-approval settings between pharmaceutical companies and payers, according to Susan A. Cantrell, RPh, CAE, CEO of AMCP.

The 340B program has evolved significantly since its passage, but there are still important changes needed, like clarifying the target patient population. The complicated rebate system for payers and drug manufacturers is also a consequence that should be addressed, said Neil Minkoff, MD, chief medical officer of EmpiraMed.

As the capabilities and benefits of e-prescribing become more widely known, states will likely continue enacting requirements to drive the uptake of this new technology, explained Doug Hillblom, PharmD, president at Arena Healthcare, LLC.

Measure developers have a number of challenges to consider when developing a new measure and getting it implemented, explained Matthew Pickering, PharmD, RPh, associate director of research and quality strategies at the Pharmacy Quality Alliance (PQA).

About 40% of new specialty drugs in 2017 are expected to be for orphan drug indications, which is keeping with the trend; however, an upcoming investigation into potential abuses of the Orphan Drug Act could have an unknown impact on development and prices, said Aimee Tharaldson, PharmD, senior clinical consultant for emerging therapeutics at Express Scripts.

With the high cost of new drugs to cure hepatitis C, ensuring that real-world outcomes are consistent with those seen in clinical trials is important, explained Gail Bridges, PharmD, of Accredo Health. She explained that Accredo ensured patients adhered to hepatitis C drugs in order to get the best outcomes through a disease- and drug-specific education program.

Findings from real-world studies will help clinicians and other health stakeholders better understand the use of Toujeo compared with Lantus, particularly regarding treatment dosage patterns, for patients with type 2 diabetes, according to Liz Zhou, MD, director of evidence-based medicine at Sanofi Medical Affairs.

According to Richard J. Willke, PhD, chief science officer of ISPOR, real-world data has some unique advantages over randomized clinical trial findings, especially for health plans looking to make coverage decisions.

Although it may be costly to negotiate and implement risk-based arrangements, these agreements are a valuable tool for testing outcomes in the real world among complex patients, explained Lou Garrison, PhD, professor emeritus in the Department of Pharmacy, University of Washington.

As healthcare moves more toward a system of value-based care, ethical committees are becoming more important to ensuring an institution's ethical values are evident in the way it provides care to patients, explained Jacqueline Glover, PhD, professor in the Department of Pediatrics and the Center for Bioethics and Humanities at the University of Colorado Denver.

Susan A. Cantrell, RPh, CAE, CEO of the Academy of Managed Care Pharmacy (AMCP), discusses the biggest concerns and opportunities facing members of AMCP during this time of legislative and regulatory uncertainty and rising costs in healthcare.